COVID-19 RISK ASSESSMENT
Please assist us in answering some basic questions to help us prepare for your arrival. You will not be turned away based on your answers, but your honesty will assist us in protecting you, our staff and the public . We thank you for your participation.
Name
First Name
Last Name
E-mail
*
Do you have any of the following symptoms?
Cough
Fever/Chills
Sore Throat
Shortness of Breath
General Body Aches
None of the Above
In the past 2-14 days have you been in contact with anyone who tested positive for COVID-19, is awaiting a test result or worked in or have you attended a healthcare facility treating patients with COVID-19?
Yes
No
Other
Anything else we should know:
*
Admin assessment
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